Specialty Care

Specialists writing on KevinMD about their practices: what private equity does when it buys a specialty group, from dermatology roll-ups to staffing companies, and whether nurse practitioners and physician assistants belong in every specialty and on what terms. Two maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Accountable care organization (ACO) and medical home differences

Kevin

Health Policy

December 13, 2010

by Kevin Fickenscher, MD

In the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.

Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the …

Check for skin cancer and melanoma, even with dark skin

Erin Marcus, MD

Conditions and Diseases

December 11, 2010

The mole on Ivis Febus-Sampayo’s face looked odd. But it wasn’t until her son needed treatment for acne that she went to a dermatologist.

“As mothers, we’re working, we’re busy,” she said. “I forgot about me and called the dermatologist to make sure my son was getting taken care of.”

The doctor removed a sliver of the mole, and reassured Ivis that it was probably nothing to worry about. Two weeks later, …

Social prejudices may limit the accuracy of patient information

Jerome Groopman, MD and Pamela Hartzband, MD

Patient

December 9, 2010

Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.

His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had …

AMA helps physicians care for patients

Cecil B. Wilson, MD

Patient

December 9, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout the stages of their careers.

Because the AMA is led by physicians, we understand the many demands and rigors physicians face as they work to provide high-quality patient care, and we are proud to support physicians in their …

Read more…

AMA helps physicians care for patients

Implementing site changes with Plan-Do-Check-Act

Donald Tex Bryant

Physician

December 8, 2010

Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients. Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill. They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.

Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making …

William Osler’s humor, and finding fun in medicine

Dr. Chris Nickson

Physician

December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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William Osler’s humor, and finding fun in medicine

Temperament of perfectionism in anorexia nervosa

William R. Yates, MD

Conditions and Diseases

December 6, 2010

Temperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development. Felt to have significant genetic components, temperament is also potentially influenced by environmental factors.

There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.

Some of the most commonly studied domains include:

neuroticism
harm avoidance
novelty seeking
reward dependence
perfectionism (subdomains have included: concern about mistakes, personal standards, doubts about actions, organization

The …

Redundant tests waste health care dollars

Doctor Grumpy, MD

Conditions and Diseases

December 5, 2010

B12.

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it’s also a good example of what’s wrong in health care.

Let’s take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks …

Sleep-breathing, your immune system, and colds

Steven Y. Park, MD

Conditions and Diseases

December 4, 2010

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?

An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is …

Lifestyle matters for specialties that want to survive

Kevin Pho, MD

KevinMD

December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

Read more…

Lifestyle matters for specialties that want to survive

A neurosurgical resident’s typical day

Colin Son, MD

Medical Education

December 1, 2010

I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.

To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …

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A neurosurgical resident’s typical day

How a plumber charges more than a neurosurgeon

S. Irfan Ali, MD

Health Policy

November 30, 2010

So there was a neurosurgeon who called a plumber for a house visit.

The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”

I mention this …

Suspicious withdrawal of a publication from an academic journal

Larry Husten, PhD

Physician

November 30, 2010

The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.

On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome …

Travelers with medical conditions fear increased TSA security procedures

Kevin

Patient

November 30, 2010

by Brian Loew

Travelers with medical conditions hope that the TSA pat-down incidents involving bladder cancer survivor Thomas “Tom” Sawyer, at Detroit Metro Airport, and to breast cancer survivor Cathy Bossi, at Dulles Airport, are isolated incidents. But these reports are already creating a chilling effect on air travel for people with medical conditions and disabilities.

This group of travelers could benefit the most from holiday …

How your medical practice can manage vendor relationships

Kevin

Physician

November 29, 2010

by Rosemarie Nelson, MS

Everyone is trying to “do more with less” and concerns about the economy add fuel to that fire! But, when done with purpose and thoughtfulness, you can manage vendor relationships so that you’ll deliver successful negotiations that will get the most bang for the buck for any medical practice, small or large, multispecialty or single specialty.

Preparation and setting objectives well before contract …

Never forget to advocate for your patient

Anesthesioboist T., MD

Patient

November 24, 2010

There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,

Listen to your “gut.”
Pay attention to the clues.
Listen to your team.
Don’t be afraid to call for help.

and

Stick to your guns when advocating for your patient.

I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been …

There is no routine procedure in general surgery

Jeffrey Parks, MD

Physician

November 23, 2010

The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.

One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …

Noninvasive fat removal in plastic surgery

Anthony Youn, MD

Conditions and Diseases

November 23, 2010

One of the hottest things in plastic surgery is noninvasive fat removal.

I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis? Does this device actually remove fat without surgery or needles?

Well, let’s review the different fat removing technologies:

1. Diet and exercise. The …

Cardiothoracic surgery has a shortage of surgeons

Kevin

Physician

November 20, 2010

by Shawn Vuong

Some time in the years 2002-2005, cardiothoracic surgery hit the wall.

The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over trained surgeons who were no longer in demand. The interventional cardiologist had come along and started stenting coronary arteries, saving patients from the chest opening …

Never hesitate to seek a second medical opinion

Eric Van De Graaff, MD

Patient

November 19, 2010

To celebrate your 50th birthday you head to your doctor’s office to get your yearly exam. He rewards you for your diligence by poking and prodding you, sticking you with needles, and arranging for a colonoscopy (happy birthday!). He also sends you for a stress test out of concern about your strong family history of premature heart disease.

A slightly abnormal treadmill test leads to …

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